The Message, January 2012

message THE

A MON T HLY NE WS M AG A ZINE OF SPOKANE COUNTY MEDICAL SOCIETY – JANUARY 2012

It’s a new year, let’s get acquainted

By Terri Oskin, MD SCMS President

New Tool for All Providers: A Uniform Pain Management Agreement Washington’s Prescription Monitoring Program

Three partners.

One focus: your health.

Introducing Rockwood Health System.

It’s the new name of the very healthy partnership

between Deaconess Hospital, Rockwood and Valley Hospital. For office visits, a trip to the E.R., surgery – or nearly anything you need – we’ve got you covered, with more than 40 locations throughout the Inland Northwest. Rockwood Health System: Working together for a healthier life.

RockwoodHealthSystem.com January SCMS The Message Open2 58453_DMC_Rockwood_7_5x10c.indd 1

11/15/11 3:54 PM

TA B L E O F C O N T E N T S

2012 Officers and Board of Trustees Terri Oskin, MD President

It’s a New Year, Let’s Get Acquainted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Anne Oakley, MD President-Elect

New Tool for All Providers: A Uniform Pain Management Agreement . . . . . . . . . . . . . . . . 1

Bradley Pope, MD Immediate Past President

Washington’s Prescription Monitoring Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD

Preventing Prescription Fraud and Illegal Representation . . . . . . . . . . . . . . . . . . . . . . . 3 Reinventing Care for Medicaid Patients: From Hot-Spotting to Tackling Social Issues . . . . . . . . 4 Salute to Medical Educators and Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 The Emergency Department Information Exchange . . . . . . . . . . . . . . . . . . . . . . . . . 5 Important Changes to 2012 Medicare Quality Reporting Program . . . . . . . . . . . . . . . . . . 6 Step UP Spokane – A Community Approach to Obesity . . . . . . . . . . . . . . . . . . . . . . . 7 Meet Paul M. Fruci of Fruci & Associates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Communities Award Given to Sterling Savings Bank . . . . . . . . . . . . . . . . . . . . . . . . . 11 AMA Seeking Nominees for Residency Review Committees and Specialty Boards . . . . . . . . . 13 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

Advertising Correspondence Quisenberry Marketing & Design Attn: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

New Physicians and Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Positions Available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Membership Recognition for January 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Classified Ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

“Let our New Year's resolution be this: we will be there for one another as fellow members of humanity, in the finest sense of the word.”

Goran Persson

January SCMS The Message Open3

It’s a New Year, Let’s Get Acquainted

Also in 2012, your SCMS will continue to partner with Greater Spokane Incorporated (GSI) to support the new medical school.

I hope many of you were able to attend the ground breaking ceremony last fall.

By Terri Oskin, MD Hey y'all. I hope everyone had a wonderful holiday season and some time to relax with family and friends. I’m delighted to be writing my first column as your president.

First, I’ll tell you a little about myself: I am an internist, and I’ve practiced with Northside Internal Medicine—part of Columbia Medical Associates—for 11 years. I grew up in Chicago and finished high school and attended college and medical school at the University of Louisvillein Louisville, Kentucky. I’m proud of my southern upbringing and I’m pretty informal, so you’ll be hearing things straight from me!

As a physician, I’m interested in diabetes management and the importance of advance directives, power of attorney and living wills. We will cover the latter in a future publication, so stay tuned. I also think it’s important to improve physician relationships on a more social and one-to-one basis.

2012 promises to be another busy and challenging year. Many of you may recall receiving a survey that asked you to describe your most important issues and concerns as a physician or physician assistant. Some of the top-ranked topics are assuring access to care, expanding Spokane’s medical school (WWAMI, UWSOM) curriculum to four years and physician reimbursement/payment reform. Besides those topics, in upcoming newsletters we will explore the controversy in imaging studies affecting radiology and neurology, physician assistant practices and medicine in the military.

January’s The Message focuses on Washington State's new law for narcotic prescribing that begins January 2, 2012. The Medical Quality Assurance Commission has set new requirements for who can prescribe chronic pain management and how much, when we need referrals for certain morphine equivalents and resources for phone consultation. The Spokane County Medical Society has diligently built consensus for a community-wide pain agreement that meets the law’s primary and essential requirements. Now that the law is real, find out what you need to know, where to go for help and get insights into how it will affect your practice.

If you are practicing good medicine and putting your patient first, the rules shouldn’t affect you much. We may all need to make some changes in our practice; however I consider the law a protection for both our patients and us. It protects us from difficult patients by providing clear guidelines on what’s acceptable and better defines our roles. I have begun handing out the new opioid agreements to patients, even those who previously signed one. I tell each patient—even my elderly grandmothers—that I’m not singling them out.

Alongside the Washington State Medical Association, we will continue working with policymakers both locally and in Washington,D.C.,to make our voices heard and to express our ongoing concerns about present reimbursement and liability reform. Later this month we will travel to Olympia and we will visit Washington, D.C., in February.

As your president, I also look forward to reuniting us as a group outside of the hospital and office. Because of so many changes in our practice (and busy personal lives), we just don't see or know each other anymore. Last year your SCMS sponsored three social events and we plan to convene more this year. Thanks to the wonderful hosting skills of Drs. Anne Oakley and Deb Harper, we have already enjoyed two successful women physician potlucks.

Now we are organizing a retreat for all women physicians to be held later this year.

I look forward to meeting more of you and I encourage you to send me your ideas and opinions. Drop me a note at TOskin@ columbiamedicalassociates.com or call me at (509)489-7483.

New Tool for All Providers: A Uniform Pain Management Agreement

By Mary Noble, MD and Lynda Williamson, DO One of the best tools for assisting all licensed prescribers in caring for chronic non-cancer pain patients is a tool known as the Pain Management Agreement. This was formerly known as a “Contract,” however that language is now antiquated. In March of 2011 the Spokane Prescription Opioid Task Force (SPOTF) formed a sub-committee with members Dr. Lynda Williamson and Dr. Mary Noble. The committee reviewed and compared pain management agreements from many medical practices in Spokane County. A set of elements that are critical to pain management agreements were developed to be compliant with Washington State’s new legal requirements. These essential components now form the basis for the Uniform Pain Management Agreement that has been approved by the Spokane Prescription Opioid Task Force and adopted by the Spokane County Medical Society (SCMS) as a community standard.

This is a timesaving device that medical practices are welcome and encouraged to adopt for their patients who need chronic analgesia that is in the form of prescribed opioids or other prescribed medications.

January SCMS The Message 1

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Continued from page 1 All of the requirements of the new Washington State pain medication law (WAC-246) are included in this agreement. In addition, the agreement was reviewed by a national legal expert in pain management and has language that can be easily read and interpreted by all education levels. The agreement fits onto the front and back of one piece of paper. Additional items can be added as needed to tailor the agreement to a particular patient and prescriber. However, nothing should be eliminated from the current agreement to assure compliance with the new legal requirements of Washington State.

The agreement is organized by first listing the essential component followed by an educational explanation for the component. The patient is asked to initial each component to assure that these essential elements have been read by the patient. Providers are encouraged to discuss any questions the patient might have about the components with the patient at the time of signing. The total agreement is then signed by both the patient and the provider.

The agreement identifies the patient’s name, date of birth, pain management provider’s name and designated pharmacy. A copy should be given to the patient to keep, another filed in the chart and copies can be filed with the Consistent Care program at Providence Sacred Heart Medical Center (PSHMC) Emergency Department (ED) for scanning into MEDITECH PCI as well as for sharing with the designated pharmacy.

Notification of area hospitals and pharmacies that a patient is a participant in a chronic pain management agreement is one of the intended outcomes of the initiative by the task force. When the hospital or emergency department staff are made aware that a patient takes chronic analgesic medications, that information can be life saving by preventing excessive dosing of analgesic medications or by preventing unintended drug-drug interactions.

A mechanism for receiving the agreements and for scanning them into MEDITECH PCI was developed by the Consistent Care Program at PSHMC ED. When a patient’s MEDITECH record is opened, for example in the Emergency Department, a banner appears on the main chart page identifying the patient as having such an agreement on file. The adoption of uniform language and components allows the simple banner to suffice as notification about the patient’s chronic pain management agreement without requiring the full document to appear on the cover page. There are links that lead the authorized reviewer of the MEDITECH record to the actual scanned agreement, if necessary. A mechanism for notification of the designated pharmacy has not yet been developed.

The agreement has been tested in some Spokane medical practices over the past three months and has been found to be well received by patients and prescribers. Patients have reported good understanding of the terms of the agreement.

The adoption of a “Uniform Pain Management Agreement” in our community helps to increase the consistency of care provided to chronic pain patients and offers one of the best practices in chronic pain management to all community providers.

The Uniform Pain Management Agreement can be found on the SCMS website at www.spcms.org under the Pain Management Resources section. The Medical Quality Assurance Commission (MQAC) rules are effective as of January 01, 2012 and are one of the sets of rules that have been promulgated. There are also sets of rules governing Osteopathic Physicians that were created by the Board of Osteopathic Medicine and Surgery (BOOMS). The Dental Quality Assurance Commission, Nursing Care Quality Assurance Commission and Podiatric Medical Board adopted rules governing their professions, in July 2011, that are in compliance with the new legislation. A link to the Washington State Department of Health website for the various sets of rules can also be found on the SCMS website.

Mary Noble, MD, FACP is the Director of the Ambulatory Care Clinic at the Internal Medicine Residency of Spokane. Dr. Noble is a Clinical Associate Professor of Medicine, U of Washington School of Medicine. Lynda Williamson, DO, ABFM is in private practice at a Center for Health and Wellness. Dr. Williamson has provided regional leadership in chronic pain management since 2007 and serves on the Washington Osteopathic Medical Association’s Continuing Medical Education Committee. She is the Regional Dean for the Pacific Northwest University of Health Sciences.

Washington’s Prescription Monitoring Program

By Chris Baumgartner, Director Washington State Prescription Monitoring Program Prescription drug misuse is a national and local problem. It has caused an alarming growth in overdose deaths, hospitalizations, admissions for substance abuse and non-medical use. In Washington, unintentional prescription pain reliever overdose deaths increased nearly 21-fold from 24 in 1995 to 490 in 2009. In the past decade, the numbers of hospitalizations for prescription pain reliever dependence and abuse have doubled, hospitalizations for methadone poisoning have increased fivefold and poisoning hospitalizations from other prescription pain relievers have increased four-fold.

The Washington State Department of Health has implemented a Prescription Monitoring Program, called Prescription Review, to address this problem. The program collects all records for schedule II, III, IV and V drugs. Prescribers and pharmacists will be able to use the information as a tool in patient care.

Dispensers began mandatory data submission on October 7, 2011. On December 1, 2011 practitioners were able to begin registering with Prescription Review for an account. On January 4, 2012 the system will become available for all practitioners to use.

January SCMS The Message 2

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Continued from page 2 Registration can be done online at www.wapmp.org.

Practitioners may request prescription history reports for their patients from the program. They will be able to access this information online 24 hours a day, seven days a week anywhere that a user has Internet access. The information provided will allow a practitioner to look for duplicate prescribing, misuse, drug interactions and other potential concerns. By having this information available before they decide on a treatment plan, a practitioner can provide improved care to their patients.

Prescribers can also authorize other licensed health professionals, like registered nurses, to access the system for them. A prescriber can delegate prescription history requests to employees who may perform similar tasks already. Sub-account users must register with the program to create their accounts.

The department will be able to use the system to alert providers when a patient to whom they have prescribed has obtained a potentially unsafe level of medication e.g. if a patient has received controlled substance prescriptions from five or more providers in the same month. By registering with the program, practitioners can receive an alert by e-mail indicating a report regarding a patient is waiting online.

Whether or not a practitioner regularly prescribes or dispenses controlled substances, this system is a valuable tool in providing better patient care. We encourage all prescribers and pharmacists to create an account. We provide electronic alerts when we identify patients with an unsafe level of dispensing.

The Prescription Monitoring Program website (www.doh.wa.gov/hsqa/ PMP/default.htm) provides more information including an option to receive updates through a listserv. The website provides frequently asked questions and a fact sheet on the program to help you use the system effectively.

Contact Prescription Monitoring Program Director Chris Baumgartner (prescriptionmonitoring@doh.wa.go) at 360-236-4806.

Preventing Prescription Fraud and Illegal Representation

By Cristina "Cris" DuVall, BA, MS, Pharm D WSPA - DIrector of Continuing Professional Development Washington State Tamper Resistant Prescription Pads (TRPP) must include: 1.

2.

3.

4.

One or more feature to prevent unauthorized copying of a completed or blank prescription form.

One or more feature to prevent erasure or modification of information written on the prescription by the prescriber.

One or more feature to prevent counterfeit prescription forms.

Board of Pharmacy seal of approval [with thermochromic ink].

To Prevent Unauthorized Copying of a Completed or Blank Prescription Form • Use hidden images of the word “Void,” “Illegal,” or “Copy” appearing when the prescription is photocopied or faxed • Use micro printed border • Display watermarks • Keep blank pads out of patient reach To Prevent Erasure or Modification of Information Written on the Prescription by the Prescriber • Use toner bond – makes all ink indelible • Have a background consisting of a solid color or pattern that is printed on the paper To Prevent Use of Counterfeit Prescription Forms • Manufacture TRPP with unique production batch numbers written in a different ink on the back of the paper • List penalties for forgeries on Security Warning Band Continued on page 4

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Continued from page 3 »» A person who illegally misrepresents, forges or alters a prescription may be imprisoned for not more than two years, or fined not more than two thousand dollars, or both. (See RCW 69.50.403) • Consider UV Fiber Secure – need a black light to see hidden fibers (not practical in pharmacies) • List the security features on the prescription paper To Prevent Written Additions to the Original Prescription • Use Latin abbreviations • Call or fax pharmacy to verify written prescription; answer • Call or fax pharmacy to verify written prescription; answer calls from pharmacy to verify • Use DEA and NPI numbers • Write clinical diagnosis in medical terms • Spell all numbers Watch for Red Flags

providers to care for patients and are paid rates by the government significantly higher than other providers due to their model of care and their inability to cost shift to private pay patients.

At Group Health, we are trying to figure out how to redesign care for our most vulnerable patients while upholding high-quality care and medical home principles. Group Health Medical Centers do not receive FQHC funding. We’ve studied practices around the nation that successfully and sustainably care for patients and they share a few qualities: 1.

They use health care teams that work together in an egalitarian and coordinated manner. The doctor is the team leader but all members share the work with the patient in mind. All team members work to the top of their license—that is, if a medical assistant can provide the service instead of the doctor, then that’s how it’s done.

2.

They recognize that many problems disrupting their patients’ care are social rather than medical. Our challenge is how to tackle these problems as a health care delivery system. For example, how will we still ensure good care if a patient isn’t showing up for visits because the clinic isn’t on a bus line or if a patient can’t afford to buy their full prescription?

• Excessive visits by patient for prescriptions especially for other people • Prescriber is writing outside of scope of practice, excessive quantities or frequencies • Incorrect prescription or label instructions, quantities, dosages • Office phone numbers/addresses changed or answered by suspicious person • Prescriptions written for antagonistic drugs on the same sheet (i.e. uppers and downers) • Multiple similar prescriptions or several patients from same office appearing in short time frame • Differently colored ink or handwriting on same prescription

Social problems require practical and creative solutions.

CareOregon—a nonprofit health plan serving Medicare and Medicaid patients in Oregon—has tried some. When it observed that a patient with asthma was chronically re-admitted into the hospital whenever the temperatures soared, it bought the lady an air conditioner. The approach resulted in the best and most costeffective outcome.

If you believe that you have a forged, altered or counterfeited prescription - don't dispense - it call your local police. If you believe you have discovered a pattern of prescription abuses,0 contact your State Board of Pharmacy or your local DEA office.

Group Health is early in the design process. We recognize it will require efficient teamwork and meeting many of our patients’ social needs. Our care will require a thorough intake process so physicians can successfully ferret out their patient’s real needs and direct them to the right resources.

Reinventing Care for Medicaid Patients: From Hot-Spotting to Tackling Social Issues

By Thomas Schaaf, MD Washington State is experiencing a deep financial crisis as it stares down a $2 billion budget shortfall. Medicaid and the Basic Health Plan are two government programs severely affected.

These populations are expensive—many have disruptive lives and reimbursements rarely cover the real cost of care. Most medical groups manage their populations two ways: They either serve a small number and shift costs to others or they see a lot more and earn supplemental government funding as a federally qualified health center (FQHC). FQHCs typically use more mid-level

We also see potential in “medical hotspotting,” described by Dr. Atul Gawande in the New Yorker as using data to flag the highestutilization patients and following up to meet their needs.

Our challenge, leading up to reform changes in 2014, is to think through these things while dealing with the Medicaid financial crunch. Many medical groups don’t have the capability or resources to do all of this. Dr. Gawande writes that the organizations which will succeed have robust utilization review plus the ability to push the levers of care delivery and health care financing and incentives. An integrated delivery system offers such an environment and supports physicians practicing as part of a system. We will let you know how it’s going.

Tom Schaaf, MD, is the assistant medical director for Group Health Cooperative’s Eastern Washington/North Idaho District. Boardcertified in Family Medicine, Dr. Schaaf has practiced at Group Health in Spokane since 1992, and founded its hospitalist program in 1997.

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Salute to Medical Educators and Leaders

• George Novan, MD, WWAMI Associate Director and Faculty, Internal Medicine Residency Spokane, has recently been awarded the following: »» Spokane County Medical Society Physician of the Year in 2010

By John McCarthy, MD, Assistant Dean for Regional Affairs, UWSOM

»» Lifetime Award - Richard M. Tucker Regional Internal Medicine Faculty Excellence

The University of Washington School of Medicine is a leader in the world of medical education with its cutting edge exploration into the future of medicine and its rich history in terms of research abilities and accomplishments within the field of medicine. It has been the prominent instructor for medical education within Washington, Wyoming, Alaska, Montana and Idaho through the WWAMI program which is now celebrating 40 years of partnership.

In our medical community, we have numbers of physician who have answered the call to become leaders within our medical organizations. It is a privilege to work with physicians of this caliber as they raise the bar for all of us. A few examples include: • Glenn Stream, MD, President of the American Academy of Family Physicians • Deb Harper, MD, Former President of Washington State Medical Association • Dean Martz, MD, Past President of Washington State Medical Association Additionally, our medical education leaders have been markedly impressed with the caliber of our local medical educators and their contributions. These are individuals with whom we rub shoulders on a frequent basis and with whom I have come to appreciate personally and professionally both in the depth of their abilities and what they bring to medical education. Currently, many physicians offer their insight, experience and mentorship to students and residents in Spokane which is noteworthy and commendable. Their peers have noted their accomplishments as well. Some of the accolades which our medical education leaders have received recently include: • Judy Benson, MD, Director, Internal Medicine Residency Spokane, acknowledged as Washington State Internist of the Year by the American College of Physicians • Kimberly Grandinetti, MD, Group Health, received the Community Teacher of the Year Award by Family Medicine Spokane • Frederick Hollon, MD, Spokane Urology, awarded the Golden Apple Teaching Award by the MEDEX program • Matthew Hollon, MD, MPH, Faculty, Internal Medicine Residency Spokane, received the 2011 Richard M. Tucker Excellence in Teaching Award from the Department of Medicine at UWSOM • Matt Layton, MD, MPH, Psychiatry Residency Site Director, awarded the Golden Apple Teaching Award by MEDEX • Henry Mroch, MD, Kidney Care Spokane, was awarded the Golden Apple Award for Outstanding Teaching by the American College of Physicians

in Teaching by the Department of Medicine at UWSOM • Theresa Schimmels, PA-C, Rockwood Clinic, awarded the Golden Apple Teaching Award by MEDEX • Judy Swanson, MD, Faculty, Internal Medicine Residency Spokane, received the Osler Award from the Spokane Society of Internal Medicine This is far from an all-inclusive list. There are literally hundreds of SCMS members who are leading and teaching in this community and thereby creating the future of medicine for our community.

We appreciate the work that they are doing and the future which they are helping shape. We salute you.

The Emergency Department Information Exchange What is EDIE? The Emergency Department Information Exchange (EDIE) is an internet delivered service that enables care providers to better identify and treat high utilization and special needs patients.

How Does EDIE Work?

EDIE provides a framework for ED Care Management where care providers can work in concert to develop and implement effective care guidelines for high utilization and special needs patients. This framework allows for both increased communication between participating facilities as well as real time delivery of crucial medical information to care providers.

EDIE can proactively alert care providers when these patients enter the ED through a variety of methods such as fax, phone, email, or integration with facility’s current EMR. Once notified, care providers can use EDIE to access care guidelines and crucial information on the patient from other participating facilities to better determine the patient’s actual medical situation.

Who Benefits from EDIE? While multiple neighboring facilities using EDIE together stand to benefit from increased communication and awareness of each other’s high utilization patients, even a hospital using EDIE in isolation benefits greatly from the ED Care Management framework that EDIE provides.

January SCMS The Message 5

Important Changes to 2012 Medicare Quality Reporting Program

Currently, physician quality reporting through PQRS is voluntary; however, the ACA mandates PQRS participation in future years.

Recently, CMS finalized regulations requiring that 2015 program penalties be based on 2013 quality reporting. Therefore, those physicians who elect not to participate or do not successfully participate in PQRS during the 2013 program year will receive a 1.5 percent payment penalty in 2015, which increases to 2 percent thereafter.

From AMA Health System Reform Insight 12/16/11 Several important changes in the Medicare quality reporting program for physicians take effect in 2012. Physicians who participate between 2011 and 2014 are eligible for incentive payments. Those who do not participate in 2013 and beyond will face a penalty beginning in 2015.

Program background First established as the Physician Quality Reporting Initiative (PQRI) for the reporting period of July 1 through Dec. 31, 2007, the program was renamed the Physician Quality and Reporting System (PQRS) in 2011. Physicians and nonphysician providers who participate in the program transmit data to the Centers for Medicare & Medicaid Services (CMS) regarding quality measures related to care provided to their Medicare patients.

CMS is required to post the names of eligible professionals and group practices who satisfactorily reported under the PQRI, which is currently available on the Medicare Physician Compare website.

The AMA advocated for timely feedback for physicians and an informal appeals process, which the Affordable Care Act (ACA) required by 2011. The ACA also required the development of an additional PQRS reporting option in 2011, allowing physicians to submit data through a maintenance of certification (MoC) program.

Physicians who elect this option can receive an additional PQRS incentive payment for three years. Details regarding the MoC reporting option, improved PQRS feedback and an informal appeals process can be found on the CMS website.

The AMA is strongly advocating for removal of PQRS penalties, particularly the linking of 2015 program penalties with 2013 performance.

Medicare PQRS incentives and penalties

2012

0.5% if no MoC; 1% if MoC

2013 (performance year for 2015 penalty)

0.5% if no MoC; 1% if MoC

2014

0.5%

2015

-1.5%

2016

-2%

2012 PQRS overview Individual reporting: Individual physicians and nonphysician providers do not need to sign up or preregister to participate in the 2012 PQRS. Submission of quality data codes for the 2012 PQRS quality measures to CMS through claims, a qualified registry or electronic health record (EHR) will indicate intent to participate in the 2012 program.

Group practice reporting option: Previously there were two classes of group practices that could use the group practice reporting option (GPRO): groups of 2–199 physicians and groups of 200 or more physicians. In 2012, there is a single GPRO for practices comprised of 25 or more eligible professionals.

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January SCMS The Message 7

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Reporting threshold: At the AMA's urging, CMS decreased

Group practices will report 29 quality measures on a certain number of consecutive patients in 2012. A group practice with 25–99 professionals is required to report 218 consecutive patients, and a group practice with 100 or more professionals is required to report 411 consecutive patients. CMS will allow practices to “skip” patients for valid reasons, such as not being able to find a patient's medical records or confirm diagnosis.

Unlike PQRS participation for individual physicians, group practices are required to submit a self-nomination letter indicating their interest in participation. More information about the 2012 GPRO option is available on CMS's website.

PQRS measures and measure groups: The 2012 PQRS program will include 210 quality measures available for claims and/or registry reporting, 26 of which are new to the PQRS program. There are an additional 51 measures available for EHR-based reporting, which includes all 44 of the Medicare EHR Incentive Program measures, five PQRS measures that were available in the 2011 EHR reporting option and two new measures CMS developed.

While CMS has eliminated the six-month reporting period for claims and registry reporting for individual measures via registry, a sixmonth reporting period remains for reporting on measures groups via a registry.

CMS also added eight measures groups for the 2012 program, bringing the total number of reportable PQRS measures groups to 22. These include: diabetes mellitus, adult kidney disease, preventive care, coronary artery bypass graft, rheumatoid arthritis, perioperative care, back pain, coronary artery disease, heart failure, ischemic vascular disease, hepatitis C, HIV/AIDS, communityacquired pneumonia, asthma, chronic obstructive pulmonary disease, inflammatory bowel disease, sleep apnea, dementia, Parkinson's disease, elevated blood pressure, cardiovascular prevention and cataracts. Because of the limitations of claimsbased reporting, some measures groups are only reportable through registries.

Measures contained in the following measures groups will be available for reporting as individual measures: diabetes mellitus, adult kidney disease, preventive care, coronary artery bypass graft, rheumatoid arthritis, perioperative care, coronary artery disease, heart failure, ischemic vascular disease, hepatitis C, HIV/AIDS, community-acquired pneumonia and asthma.

Alignment of the Medicare PQRS and EHR Incentive Program: To align the PQRS with the Medicare EHR Incentive Program, all clinical quality measures available for reporting under the Medicare EHR Incentive Program will be included in the 2012 PQRS. This will allow physicians to report data on quality measures under the EHR-based reporting option.

the threshold for successful PQRS claims-based reporting from 80 percent to 50 percent starting in 2011. This reporting threshold will continue for the 2012 program year.

Informal appeals process: In 2012, an eligible professional electing to utilize the informal appeals process must request an informal review within 90 days of the release of his or her feedback report, regardless of when the participant actually accesses his or her feedback report. CMS has extended the time the agency has to respond to the request for an informal review from 60 days in 2011 to 90 days for 2012.

PQRS payment adjustment: Despite strong opposition from the physician community, CMS has designated 2013 as the reporting period for the 2015 PQRS payment penalty. Therefore, if CMS determines that an eligible professional or group practice has not satisfactorily reported data on quality measures for the Jan. 1– Dec. 31, 2013 reporting period for purposes of the 2015 payment penalty, then the fee schedule amount for services furnished by the participating professional or group practice during 2015 would be 98.5 percent of the fee schedule amount that would otherwise apply to such services.

Refer to CMS's website for additional information on PQRS, including measures, measures groups, reporting options and periods.

AMA PQRS participation tools The AMA is developing participation tools for both the individual quality measures and measures groups eligible for claims-based reporting in the 2012 PQRS program. These tools will soon be available on the AMA website. Please email questions or comments about the tools to cpe@ama-assn.org.

Step UP Spokane – A Community Approach to Obesity

By Hal Goldberg, M.D. Step UP Spokane Founder and Chairman of the Board and Julie Humphreys, Director Step Up Spokane Obesity – say the word and most of us want to ignore it… it is frustrating to deal with and we have had little success with our patients. We cannot ignore that obesity is creating an increasing toll on our patients and the health care system. The statistics from the NHANES database paint a grim picture of the demographics of the disease. The numbers – 34% of US adults are obese, and 68% are either overweight or obese. The cost of obesity in medically related healthcare costs - $150 billion dollars annually. The hidden costs of obesity are more obvious to those of us who work in the hospital and have seen the altered environment.

Continued on page 9

January SCMS The Message 8

Continued from page 8 Larger beds, more durable wheel chairs, cath tables structurally reinforced to support increased weight, and enlarged MRI scanners, all to accommodate larger individuals are now commonplace.

As physicians, we may believe we all have the discussion in the office regarding patients’ obesity. However, a 2006 survey revealed that only 65% of obese patients were advised by their physician to lose weight. Health care individuals playing a role in this interaction recognize a lack of skills, knowledge and practical tools to deal with obesity. But, is the office the only battleground to attempt to wage war on this disease? As mentioned in the August Circulation article regarding cardiovascular health and obesity - “Preventing a disorder makes more sense than treating one; this concept holds especially true for obesity.” We also have an obligation to think about our children. A recent study from US National Longitudinal Study of Adolescents Health found that obese adolescents were 16 times more likely to develop severe obesity than normal weight or overweight adolescents.

How do we as physicians respond to the crisis? There are two settings to deal with the problem. One is the office, in face-toface contact with the patients. It is challenging and as an article in Circulation, August 8, 2011 points out in a review of the critical elements to improve success. The other setting is the public arena, which warrants a change in the culture. This is a bold concept, but it has potential for the largest impact. There is evidence through the CDC that population based approaches to weight loss and improved medical outcomes have been cost effective.

Bloomsday training tools for 2011 and will again in 2012. We are part of a WSU study to compare the success of internet based exercise training vs. the latter plus coach based training. Future developments will include group/team exercise and nutrition challenges that can be used by corporations or individuals and cooperative efforts with local restaurants to develop menus with tasty items that are healthy and have fewer calories.

Step UP Spokane is a community-based effort to forge an initiative to improve community health. The Surgeon General, Dr. Regina Benjamin, in January 2010 stated, “Our nation is at a crossroads. Today’s epidemic of overweight and obesity threatens the historic progress we have made in increasing America’s quality and years of healthy life. The future is unacceptable. I ask you to join me in combating this crisis.”

Members of Spokane County Medical Society are encouraged to write pieces for the Step UP Spokane blog or provide financial support with contributions to cover the costs of additional program development. Those donations are tax deductible through the Spokane Area Business Foundation of GSI. For more information, please contact the Step UP Director, Julie Humphreys at julie@stepupspokane.org.

Oklahoma City launched such a campaign several years ago when the Mayor challenged the city (ranked the fattest in the nation) to lose a million pounds. To date they are almost there at nearly 950,000 pounds lost and more than a million miles of movement logged on the campaign’s website. Recognizing this success, a core group of individuals representing organizations vested in the healthcare of Spokane, worked together to develop an organization, Step UP Spokane, committed to address this issue.

Step UP’s mission is to promote healthy lifestyles by encouraging people to engage in daily physical activity and healthy eating with a web based resource. The Step UP website, stepupspokane.org, has engaging physical activity trackers, helpful health information, healthy recipes, a local activities calendar, an active social networking element and more. There is no shortage of web based activity trackers and programs. The ones that are successful in helping people change behavior have something more. They provide a sense of community, a place for people to connect with other local people and are supported by organizations with proven track records of caring for their communities. Step UP provides all the above! Rack cards are available to direct your patients to the web site.

Launched October 2010, there have been a number of successes during the first year. There are more than 1,900 people registered on the web site, many of whom have completed exercise challenges. Step UP Spokane served as the web site for

Thank you to our generous 2012 “building momentum” and “making it happen” sponsors; Premera Blue Cross, Family Home Care, Inland Northwest Health Services, Spokane Cardiology, Spokane County Medical Society, Spokane Regional Health District, Providence Health Care and YMCA of the Inland Northwest.

January SCMS The Message 9

Meet Paul M. Fruci of Fruci & Associates, P.S. – An SCMS Community of Professionals Partner

What is your thinking about the Spokane area medical community?

We are blessed to have the medical expertise and diversity here in Spokane. In these troubled times it is more important than ever that we support the work they are doing by helping them with the nonmedical aspects of their practices and lives so that they can continue the great care they have provided.

In The News Eric Sohn, MD Chosen for Award Dr. Eric Sohn has been chosen the Medical Director of the Year

Self-introduction

for Northwest Division by Life Care Centers of America. Dr. Sohn

received his medical degree in 1996 from the University of Nevada

My name is Paul M. Fruci. I am

School of Medicine. He completed his residency at Genesis Medical

a CPA and president of Fruci &

Center in Iowa. In 1999 he began practicing medicine in Spokane

Associates, P.S. a professional

County at which time he also become a member of the Spokane

service corporation. Fruci

County Medical Society.

& Associates was started by my father and has been in business since 1938.

In Memoriam

How long have you be in Spokane?

David G. Kramp M.D.

I have lived in Spokane my entire life a total 65 years. I am a graduate of Gonzaga Prep and followed up with my B.A. in Business Administration from the University of Gonzaga.

What service do you provide for professionals?

I provide tax preparation for individuals, trusts, estates, partnerships and corporations. I also conduct business valuations, offer litigation support and help with buy/sell negotiates.

What makes your organization stand out as a “good” partner?

As a public accounting firm we are able to work with various sizes and types of organizations and individuals. Back in the 50s my father was the first in this area to provide focus and service to the medical community as a main focus. Our staff offers a wide range of experience and knowledge. Since our company is a family-owned business, we try to use this approach with our staff and clients.

Some of our clients are the third generation to work with our firm.

We embrace all clients, from old to new, with the same approach.

We work with our clients to help them identify their needs and to establish their goals.

David G. Kramp passed away December 8, 2011 in Spokane, WA. He was born September 10, 1936 in Springfield, IL, the son of Louis and Dorothy Kramp.

David attended grade school in Springfield, Loyola Jesuit High School in Chicago, IL as well as Jesuit High School in Detroit, MI. He attended one year of college at Catholic University of America and three additional years at the University of Notre Dame, graduating in 1958. David attended medical school at St. Louis University, and graduated in 1962. That same year, David married Ann Swan of Edmonton, Alberta, Canada. He then interned at St. Louis Group University hospitals. David was a Captain in the U.S. Army from 1963-1965, and served as a physician at Fort Belvoir, VA. He completed his internal medicine residency at Marquette University and did one year fellowship in rheumatology at UCLA. Dr. Kramp then went into practice at Richland Clinic for five years. In 1974 he moved to Spokane to practice internal medicine with Jim McCallister, M.D. and LeRoy Byrd, M.D. at Holy Family Hospital. David retired in the summer of 1998 to enjoy his children and grandchildren. Dr. Kramp leaves behind his loving wife of 50 years, Ann Kramp of Spokane; children Steve (Sarah) Kramp of Gig Harbor, WA, Tina Kramp of Spokane, Mary Therese (Bill) Akers of Spokane, Lou (Cari) Kramp of Redmond, WA, Amy Jo (Ciro) Royster of Spokane, Jill (Jon) Herendeen of Thousand Oaks, CA, and Michael (Rita) Kramp of Salisbury, PA; and 17 grandchildren.

January SCMS The Message 10

2011 Corporations for Communities Award Given to Sterling Savings Bank – An SCMS Community of Professionals Partner Washington Secretary of State Sam Reed visited Sterling Savings Bank’s downtown Spokane headquarters November 18 to present the bank with the 2011 Corporations for Communities Award, the state’s most prestigious civics award. Secretary Reed awarded Sterling CEO Greg Seibly with the National Association of Secretaries of State Medallion, which recognizes voter education efforts, civic engagement, government services and a commitment to giving back in the community.

“At Sterling we do not measure success simply by whether we are making a profit, we also measure success by whether we are making a difference,” Seibly said after accepting the award. The Sterling-hosted reception also included various leaders from area businesses and non-profits, including Spokane County Medical Society CEO Keith Baldwin.

Sterling was selected for the honor for its various communitygiving efforts, which include sponsoring the Spokane Symphony Labor Day Comstock concert. Sterling employees in 2011 already have donated more than 30,000 hours to national causes like Habitat for Humanity, Junior Achievement and United Way and regional charities like food banks and civic organizations.

Additionally, in a given year, Sterling donates to more than 300 health, education, youth, community, and arts and culture organizations throughout its five-state footprint.

Washington Secretary of State Sam Reed (right) presents Sterling Savings Bank CEO Greg Seibly with the National Association of Secretaries of State Medallion.

Visit our updated website • View "The Message" Online

• Legislative updates

-Full current and past issues available

-Connect with SCMS on Facebook and stay informed

• Membership information

• Connect to Medicor

-Information about credentialing, committees, bylaws, etc.

-The online medical library is a SCMS membership benefit.

• CME information -Topic and dates for upcoming CME courses

January SCMS The Message 11

Providence proudly opens a new northside primary care clinic.

Providence Medical Group opens a new convenient northside primary care clinic at 551 East Hawthorne. New patients are welcome – please call to schedule an appointment.

The following providers have joined the Hawthorne clinic: • Elizabeth O’Halloran, MD, family medicine • Kathleen Moudy, PA-C, pediatrics

Call now for an appointment 509.252.1900.

PROVIDENCE FAMILY MEDICINE PROVIDENCE PEDIATRICS For a complete listing of Providence Medical Group physicians and clinic locations, visit our website at phc.org. phc.org

January SCMS The Message 12

Providence Medical Group - Hawthorne 551 East Hawthorne • Spokane 99218

AMA Seeking Nominees for Residency Review Committees and Specialty Boards Each year the American Medical Association (AMA) solicits recommendations from numerous sources for possible appointments to Residency Review Committees (RRC) or nominations to American medical specialty boards. The Board of Trustees knows many AMA members are well qualified for appointment to these committees, but their names and credentials have not been brought to its attention.

We request your assistance to identify the most qualified individuals.

Nominations are needed to fill fourteen positions on thirteen RRCs: Dermatology, Radiology Diagnostic, Emergency Medicine, Family Medicine, Medical Genetics, Nuclear Medicine, Orthopaedic Surgery, Pathology, Pediatrics, Radiation Oncology, Psychiatry, Surgery and Thoracic Surgery.

As background, twenty-seven RRCs propose revisions to the standards for the accreditation of residency programs in their specialty and determine if individual residency programs are, or are not, in substantial compliance with the standards approved by the Accreditation Council for Graduate Medical Education (ACGME).

If selected, RRC nominees will be required to complete an ACGME nomination form and the ACGME Review Committee Member Agreement. As the ACGME form is very similar to the AMA form, we advise you and your candidate to retain a copy of the AMA form as it will be of assistance to you in completing the ACGME form. For a copy of the ACGME form and additional information about the ACGME appointment process please visit http://www. acgme.org/acWebsite/rcreviewcommittees.asp.

In addition, nine of the American medical specialty boards ask the AMA to submit recommendations for their respective Board of Directors. Specialty boards that may consider AMA nominations for upcoming vacancies are also attached. A completed form is required for all nominees wishing to be considered for nomination by the AMA to American medical specialty boards with the exception of answering questions 10 through 13. All forms and CVs should be sent to Evelyn Sherrill at evelyn.sherrill@ama-assn.org.

All nominees to Residency Review Committees or American medical specialty boards must be current AMA members. For more information contact Evelyn Sherrill at the e-mail listed above or by phone (312) 464-4515.

The AMA has identified the following desired qualifications for nomination to RRCs: 1) specialization in the discipline; 2) national recognition in the specialty; 3) current or recent experience as a residency program director and current involvement in teaching resident physicians; 4) knowledge of the process of accreditation; and 5) knowledge of the AMA as an organization representing the medical profession. Each RRC has also identified specific characteristics which can be found on the attached pages.

The AMA Council on Medical Education initially reviews the credentials of potential nominees and submits its recommendations to the AMA Board of Trustees for final nomination by the AMA. In accordance with the “Policies and Procedures” of the ACGME, residency review committee appointments are reviewed by the respective RRC and must be confirmed by the Board of Directors of the ACGME. RRC appointments are for one six-year term and are non-renewable.

To complete the recommendation form go to the AMA’s Council on Medical Education’s web site at www.ama-assn.org/go/ councilmeded. We strongly encourage submission of the form as a WORD document. We also require an electronic version of an abbreviated current curriculum vitae (not to exceed three pages) of the individual(s) you are recommending for appointment(s). Please email the CV and the nomination form, along with a signed copy of the form indicating the nominee is aware of AMA’s conflict of interest statement to Evelyn Sherrill at evelyn.sherrill@ama-assn. org. The forms must be received no later than February 1, 2012.

Any recommendations submitted in the past must be resubmitted in order for the candidates to be considered by the AMA.

January SCMS The Message 13

Continuing Medical Education STD Update - The Spokane Regional Health District and the Seattle STD/HIV Prevention Training Center sponsored two-day STD Update course January 19 and 20 at St. Luke’s Rehabilitation Institute in Spokane. This course provides participants with training in the most recent advancements in the epidemiology, diagnosis and management of viral and bacterial STDs, and was designed for clinicians in the Spokane area who diagnose and treat patients with sexually transmitted infections. CMEs and CNEs are available.

Presentations will be conducted by several notable figures including Dr. Jeanne Marrazzo, current Medical Director of the Seattle STD/ Sexually Transmitted Diseases/HIV Prevention and Training Center, and Dr. Devika Singh, Internal Medicine Physician of Seattle, Washington. The cost to register is $100. Seating is limited and pre-enrollment is required by January 10. CME: The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Washington School of Medicine designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Please visit www.seattlestdhivptc.org for online registration and payment information. Any additional questions can be directed to Alexandra Hayes, Health Program Specialist at the Spokane Regional Health District at 509-324-1635 or ahayes@spokanecounty.org.

Promoting Healthy Families (Practice Management Alerts from the American Medical Association ) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Inland Northwest Academy of Family Physicians – 13th Annual Winter Retreat and CME Conference February 3 (Noon to 7:00 p.m.) and 4 (7:30 a.m. to Noon), 2012 Red Lion Hotel at the Park. 7 Prescribed credits have been applied to American Academy of Family Physicians. Registration Fee $95 (INAFP members) $110 (nonmembers). Contact Camtu Thai, MD at (509) 710-9862 or email thai.c@ghc.org

Update in Internal Medicine 2012: This seminar is jointly sponsored by the Spokane Society of Internal Medicine. Conference will be held on February 24-25, 2012 at the Spokane Convention Center. Please view the SSIM website at www.spokanesocietyim.org for a program brochure and registration form. Contact Jennifer Anderson at (509) 448-9709 or email spokanesocietyim@gmail.com for more information.

Meetings, Conferences and Events Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

Caduceus Al Anon Family Group – Meets every Thursday evening from 6:15 pm until 7:15 pm at 626 N. Mullan Road, Spokane, WA. Non-smoking meeting for spouses and significant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact 509-928-4102 for more information.

Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental illness, addictions, work-related stress, life transitions, and relationship difficulties. The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees. Contact Bob or Carol at 509-624-7320 for more information.

E-prescribing Narcotics Webinar – Stay on top of the rules and regulations of e prescribing and the future opportunities for eRx of narcotics. There will be implementation in 2012 of this topic, especially since Washington State has already adopted the DEA rules on the subject that were created in 2010, but there are many steps for providers, hospitals and pharmacies to make that happen.

February 21, 2012 Noon – 1 p.m. SCMS Conference Room. Limited registration. Call (509) 325-5010 for more information.

WSMA Practice Management Seminar 2012 CPT Coding Updates & Medicare Billing and Payment Issues - Morning seminar: 2012 CPT Coding Updates (9:00am-12:30pm) Learn the latest requirements on these issues: Introduction and overview of 2012 CPT® changes: Added codes, revised codes, and deleted codes; general changes, including guidelines, modifiers and E/M codes; CPT® 2011 re-sequencing principles; coding updates.

Afternoon seminar: Medicare Billing and Payment Issues (1:305:00pm) Hands-on education program on Medicare. Attend both sessions for a discounted fee. Spokane Valley (Tuesday, January 10) Register on line at www.wsma.org. For more information contact Michelle Lott by phone at 1 (800) 552-0612 or mml@wsma.org.

January SCMS The Message 14

The following physicians/physician assistants have applied for membership, and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS

PHYSICIANS PRESENTED A SECOND TIME Knorr, Roberta L., MD Pediatrics Med School: Universidad de Montemorelos, Mexico (1983) Internship: Loma Linda U (1984) Residency: White Memorial Medical Center (1986) Fellowship: Loma Linda U Medical Center (1988) Practicing with CHAS beginning 1/2012 Louie, Helen, MD Obstetrics and Gynecology Medical College of Pennsylvania (1994) Internship/Residency: UMDNJ, Robert Wood Johnson U (1998) Joining Deaconess Perinatal Services since 12/2011

Krane, Bjorn B., MD Neurology Oregon Health and Science U (2000) Internship: U of Pittsburg Medical Center (2001) Residency: Rush U and Medical Center (2004) Fellowship: U of Chicago (2005) Joining Deaconess Hospital beginning 3/2012

O’Halloran, Elizabeth K., MD Family Medicine Duke U (2003) Internship/Residency: Duke U Medical Center (2005) Residency: Oregon Health and Science U (2007) Joining Providence Medical Group, Hawthorne since 12/2011

Primm, Jane C., MD Diagnostic Radiology U of Washington (1985) Internship: Forest Park Hospital (1986) Residency: U of California, Davis (1992) Fellowship: Oregon Health and Sciences U (1993) Joining Radia, PS beginning 1/2012 Shaw, Amie R., DO Family Medicine Med School: Touro U, College of Osteo Medicine (2008) Internship/Residency: Family Medicine Spokane (2011) Practicing with Group Health since 7/2011

Walkes, Jon-Cecil M., MD Thoracic Surgery U of California, Los Angeles (1996) Internship/Residency: Baylor College of Medicine (2001) Fellowship: Baylor College of Medicine (2003) Joining Deaconess Hospital beginning 3/2012

January SCMS The Message 15

POSITIONS AVAILABLE PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane. We are recruiting for BE/BC Urgent/ Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply). This is a great opportunity to join a growing employed medical group in beautiful eastern Washington. The exceptional Providence care team is implementing a system-wide standardized EHR and providers benefit from shared best practices and robust clinical and business support. Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane.

Competitive compensation and excellent benefits package, including relocation. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearrick@providence.org, www.providence.org/physicianopportunities.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs.

Contact: Mark Rearrick, mark.rearrick@providence.org, (509) 4746605, www.providence.org/physicianopportunities.

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Toni Weatherwax at (509)444-8888 or hr@chas.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy.

The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at 1-800-260-1515 x5366 or email gmelkus@ qtcm.com or visit our website www.qtcm.com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments.

We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@ palousemedical.com. Contact us today and discuss your future at Palouse Medical!

CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide. OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally.

Learn more at www.OctapharmaPlasma.com! APPLY TODAY! Apply today by sending your resume/CV to Careers@OctapharmaPlasma.com!

PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com.

FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at 509-459-0688 or e-mail at BorgwaD@fammedspokane.org.

PROVIDENCE SACRED HEART CHILDREN’S HOSPITAL (Spokane, WA) is seeking a BE/BC Pediatric Hospitalist to join our inpatient team. Be part of an exceptional care-team serving children from four inland Northwest states. Work closely with the Pediatric Trauma Center, general pediatric unit, PICU, NICU (level III), and Pediatric Surgery known for exemplary care. Strong cross-specialty support, state-of-the-art equipment and technology, and wonderful quality of life in sunny eastern Washington. Competitive compensation and excellent benefits package, including relocation. Sacred Heart Medical Center and Children’s Hospital has 623 beds, a medical staff of more than 900 and a service area population of about 1.5 million. The children’s hospital alone includes more than 90 pediatric sub-specialists. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearric@providence.org, www. providence.org/physicianopportunities.

WANTED... NURSE PRACTITIONER FOR NORTH SIDE FAMILY PRACTICE OFFICE. Looking for a dynamic & energetic NP with 3 years practice experience (preferably in family medicine). 30-35 hours/week, one weekend call every 3 months. Communication skills and concise charting skills a must! Send resumes to: lfisher@inwhealth.net.

January SCMS The Message 16

January SCMS The Message 17

Membership Recognition for January 2012

William S. Coleman, MD

1/26/1982

Jan S. Connelly, MD

1/26/1982

Steven E. Goodell, MD

1/26/1982

Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

Robert Hander, MD

1/26/1982

Meredith A. Heick, MD

1/26/1982

Halford B. Holte, MD

1/26/1982

50 Years

Alexander R. MacKay, MD

1/26/1982

Victor E. Castleberry, MD

1/11/1962

Stephen C. Maher, MD

1/26/1982

Lowell E. Horlacher, MD

1/11/1962

Michael M. McCarthy, MD

1/26/1982

Hampton W. Irwin, MD

1/11/1962

Arnold G. Peterson, MD

1/26/1982

Alden R. Parker, MD

1/11/1962

Pamela Gee Silverstein, MD

1/26/1982

Steven V. Silverstein, MD

1/26/1982

40 Years Hrair A. Garabedian, MD

1/25/1972

30 Years James A. Numata, MD

1/25/1982

Gary E. Cantlon, MD

1/26/1982

10 Years Leann Bach, PA-C

1/28/2002

Daniel R. Rhoads, PA-C

1/28/2002

See You on the Internet The 2010 Washington State legislature passed a bill in response to concerns about the See You onrisks the Internet consequences and of prescribing opioids for chronic, non-caner pain. In response, five boards and commissions adopted numerous regulations related to pain management.

The 2010 Washington State legislature passed a bill in response to concerns about the To help you understand other related we've startedpain. an ever-growing consequences and this risks and of prescribing opioids issues, for chronic, non-cancer In response, list five boards and commissions adopted numerous regulations related management. of guidelines, informational resources and CME opportunities in to thepain important areas of To help you understand this and other related issues, we’ve started an ever-growing list chronic pain management and opioid-related disorders. To view please go to theof "Pain guidelines, informational resources and CME opportunities in the important areas of Management page and of the SCMS website at To http://tinyurl.com/78yhvxg. chronicResources" pain management opioid-related disorders. view please go to the “Pain

AD OR ARTICLE

Management Resources” page of the SCMS Website at http://tinyurl.com/78yhvxg.

Below are two CME opportunites that can be found at the SCMS website.

Below are two CME opportunities that can be found at the SCMS website.

January SCMS The Message 18

REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including fullsized washer and dryer. Wired for cable and phone. For Rent $ 850/ month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres. For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen. For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker. Everything to accommodate you & your equestrian needs. Offered by John L Scott Real Estate – John Creighton at (509) 979-2535. For a virtual tour www.tourfactory.com/709316.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include ediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease.

Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com.

MEDICAL OFFICES/BUILDINGS Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old.

Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community. If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease.

Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 - 2190 sq/ft For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $22 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services. For more information, call (509) 981-9298.

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals.

Phone (509) 535-1455 or (509) 768-5860.

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Three partners.

One focus: your health.

Introducing Rockwood Health System.

It’s the new name of the very healthy partnership

between Deaconess Hospital, Rockwood and Valley Hospital. For office visits, a trip to the E.R., surgery – or nearly anything you need – we’ve got you covered, with more than 40 locations throughout the Inland Northwest. Rockwood Health System: Working together for a healthier life.

RockwoodHealthSystem.com

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11/15/11 3:54 PM

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

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